What are the Concerns Regarding Electronic Health Records?
What are the Concerns Regarding Electronic Health Records? As there are many advantages and benefits to an EHR, there are also some concerns associated with the electronic medical record system. Studies highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. 'Financial Concerns' Financial issues, including adoption and implementation costs, ongoing maintenance costs, and loss of revenue associated with temporary loss of productivity, present a disincentive for hospitals and physicians to adopt and implement an EHR. The costs of EHR adoption, implementation, and ongoing maintenance are compounded by the fact that many financial benefits of an EHR generally do not accrue to the provider (who is required to make the upfront investment) but rather to the third-party payers in the form of errors averted and improved efficiencies, which translate into reduced claims payments. This misalignment of incentives for health care organizations, along with the high upfront costs, creates a barrier to adoption and implementation of an EHR, especially for smaller practices. In fact, physicians frequently cite upfront costs and ongoing maintenance costs as the largest barriers to adoption and implementation of an EHR. Furthermore, the average physician lost nearly $44,000 over five years of implementing an EHR, according to recently research published in Health Affairs. Just 27 percent of physicians in that study achieved a five-year positive return on investment and only 14 percent more would come out ahead if Meaningful Use payments were factored in. 'Productivity Concerns' Another disadvantage of an EHR is disruption of work-flows for medical staff and providers, which result in temporary losses in productivity. This loss of productivity stems from end-users learning the new system and may potentially lead to losses in revenue. Only 57 percent of users said that their EHR made them more efficient. 'Privacy Concerns' Another potential drawback of EHRs is the risk of patient privacy violations, which is an increasing concern for patients due to the increasing amount of health information exchanged electronically. To relieve some of these concerns, policymakers have taken measures to ensure safety and privacy of patient data. For example, recent legislation has imposed regulations specifically relating to the electronic exchange of health information that strengthen existing Health Insurance Portability and Accountability Act privacy and security policies. 'Unintended Consequences' EHRs may cause several unintended consequences, such as increased medical errors, negative emotions, changes in power structure, and overdependence on technology. Researchers have found an association between the use of CPOE and increased medical errors due to poorly designed system interfaces or lack of end-user training. Additionally, end-users of an EHR may experience strong emotional responses as they struggle to adapt to new technology and disruptions in their workflow. Changes in the power structure of an organization may also occur due to the implementation of an EHR. For example, a physician may lose his or her autonomy in making patient decisions because an EHR blocks the ordering of certain tests or medications. Overdependence on technology may also become an issue for providers as they become more reliant upon it. Organizations should ensure that basic medical care can still be provided in the absence of technology, especially in times when the downtime of the system may be critical. 'Statistics' Study findings show that: *39 percent of clinicians would not recommend their EHR to a colleague, up from 24 percent who said so in 2010. *With regard to ability to improve patient care, the "very satisfied" group dropped by 6 percentage points, while the "very dissatisfied" group grew by 10 points. *Surgical specialists were the least-satisfied group, while primary-care doctors were the more satisfied; medical sub-specialties fell between the two. *Satisfaction with ease of use fell 13 percentage points. Thirty-seven percent reported increased dissatisfaction. *34 percent of users were "very dissatisfied" with the ability of their EHR to decrease workload, up from 19 percent in 2010. *Respondents also said it is becoming more difficult to return to pre-EHR implementation productivity levels. In 2012, 32 percent of respondents said they had not returned to the previous level of productivity; 20 percent said so in 2010. NEXT: The Impact of Electronic Health Records on Patients